Author: Dr Roy Palmer
Vitiligo is a condition in which areas of skin lose their pigment. It affects approximately 1 in 50 people. The most common type is the generalised type, in which multiple areas develop. Another type is segmental vitiligo, in which only one segment of the skin is affected.
Generalised vitiligo often affects the skin of the face, armpits, elbows, wrists, fingers, lower back, knees, shins and feet, but any area can be affected. On the face the affected areas are often around the eyes and mouth. Usually the depigmentation occurs in relatively small patches initially, with subsequent spread at intervals over many years. It tends to be most noticeable in people with dark skin. On average it begins at the age of about 20, but it can begin in early childhood or late adult life.
It is due to an autoimmune process; the body makes an immune response against its own pigment cells. For this reason, people with vitiligo are more likely to have other autoimmune conditions; approximately 1 in 6 people with vitiligo also develop an autoimmune disease of the thyroid gland. It is partly genetic; patients sometimes have a history of it in the family. It is not ‘catching’. It often has a major psychological impact on the person affected. One of the reasons for this is that the face and hands, which are visible despite clothing, are frequently involved by the condition.
The diagnosis is usually made on the basis of the appearance. Without treatment the loss of pigmentation is usually permanent, but at least some spontaneous repigmentation does sometimes occur (usually after sun exposure). Treatment can be difficult, but is sometimes successful; ointments (particularly one called Protopic) or narrowband ultraviolet-B (NB-UVB) phototherapy are particularly used. Courses of NB-UVB often have to involve many treatment sessions. ‘Cosmetic camouflage’ and other forms of disguising the affected areas can be used. Other treatments sometimes used include steroid creams, sun avoidance (to avoid the normal unaffected skin from tanning, which makes the affected areas more noticeable), laser treatment and surgical treatment. There are many treatments currently being assessed in clinical trials around the world.
Segmental vitiligo is believed to be very different in terms of its cause and prognosis. The loss of pigmentation affects only one area; for example, the left side of the chest might be involved. It does not usually spread to involve other areas.
The Vitiligo Society are an excellent UK support organisation;
Vitiligo Support International have a lot of detailed information on their website;